The high cost of critical care unit over-utilization for patients with NSTE ACS - 31/07/18
, Dat T. Tran, MPH c, d, Justin A. Ezekowitz, MBBCh, MSc b, c, David A Zygun, MD a, d, Jason N Katz, MD, MHS e, Renato D. Lopes, MD, PhD f, L. Kristin Newby, MD, MHS f, Finlay A. McAlister, MD, MSc c, g, Padma Kaul, PhD b, cAbstract |
Background |
There is substantial variability among hospitals in critical care unit (CCU) utilization for patients admitted with non-ST-Segment Elevation Acute Coronary Syndromes (NSTE ACS). We estimated the potential cost saving if all hospitals adopted low CCU utilization practices for patients with NSTE ACS.
Methods |
National hospital claims data were used to identify all patients with a primary diagnosis of NSTE ACS initially admitted to an acute care hospital between 2007 and 2013. Hospital CCU utilization was classified as low (<30%), medium (30–70%), or high (>70%).
Results |
Among the 270,564 NSTE ACS hospitalizations (71.6% non-ST-segment elevation myocardial infarction; 28.4% unstable angina) admitted to 261 hospitals, 41.9% (inter-hospital range 0.3%–95.1%) were admitted to a CCU. The proportion of patients admitted to a CCU in low, medium and high utilization hospitals was 16.3%, 49.5%, and high 81.1%, respectively. No differences in adjusted inpatient mortality were observed by hospital CCU utilization. The overall inpatient costs of caring for NSTE ACS were $1.1 billion. CCU care accounted for 45.2% of all hospitalization costs including 22.6%, 49.9%, and 69.0% (P < .001) of costs in low, medium and high utilization centers. The national potential direct cost savings of medium and high CCU utilization centers adopting low NSTE ACS CCU utilization practices was $113.4 million over the study period.
Conclusions |
In a population-based contemporary cohort, CCU utilization for patients with NSTE ACS varied widely and in-hospital mortality was similar between low, medium and high utilization centers. CCU care accounted for 45% of hospitalization costs; thus, implementing policies and admission practices to align hospital resources with patient care needs have the potential to reduce overall health care costs.
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| Funding Statement: This analysis was funded by a grant from the University Hospital Foundation. |
Vol 202
P. 84-88 - août 2018 Retour au numéro
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